• The Twelfth Ribs

    While working on a regular client who is in the middle of a move and has been working very, very hard I discovered that her back pain could be due to her twelfth rib being twisted and moving anterior to her eleventh rib. The twelfth rib has many muscles attaching to it and can cause pain in many areas. Following is a list of the muscles attaching to the twelfth ribs:

    • External oblique
    • Internal oblique
    • Transversus abdominis
    • Diaphragm
    • Serratus posterior inferior
    • Latissimus Dorsi
    • Iliocostalis
    • Quadratus lumborum
    • Internal intercostal
    • External intercostal

    This is quite a bit of muscle tissue to attach to such a small bone. Periodically in a class a student will ask me about the old rumor that celebrities had their twelfth ribs removed to create a more defined waistline. I cannot imagine this. What would they do with all the muscles attaching to the twelfth ribs? If digitations of those muscles were left hanging out, odds are at least a few of them would bind to other muscle fibers, either within the same muscle or in a different muscle. This binding would not create a smooth or more defined waistline. Although students will tell me that they are sure this surgery has been done a time or two, I cannot imagine the logistics of it, so I continue to believe it would not accomplish the desired results and therefore would be undesirable and not done.

    Final Back w_label5

    The twelfth ribs can be pulled in many directions by all these large, strong muscles attaching to them, but their position can just as easily be effected by posture. Someone who has tight adductor muscles that are pulling the pubic bone inferior toward the thigh and creating an anterior pelvic tilt and an increased lordotic curve may have twelfth ribs that have moved anterior in response. Someone who collapses their anterior lower ribcage while sitting, moving the anterior lower ribcage inferior and posterior, may have twelfth ribs that have moved posterior and possibly superior. While someone whose hips are twisted (i.e. one side is anterior while the other side is posterior) may see a twist in the floating ribs that either mimics the hips or goes opposite the hip pattern.

    Again, my question would be: What happens to the muscle tissue? Each time you feel a twelfth rib that is shifted, imagine what is happening to each of the muscles listed above. Pain from a shifted twelfth rib can be felt in the shoulder (latissimus dorsi), in the abdomen (external oblique, internal oblique, transversus abdominis, diaphragm), and/or in the lower back (serratus posterior inferior, iliocostalis, latissimus dorsi, quadratus lumborum). It is also possible that a shifted twelfth rib will influence the position of the first rib, causing pain in the superior shoulder, and possibly some thoracic outlet symptoms.

    The twelfth rib is a small bone that many of us pay little attention to until it hurts. Its position is important to our posture and muscle balance. It is extremely easy to locate and work with. Many times when the twelfth rib is released the muscles attaching to the twelfth rib will instantly ease. It is time we pay more attention to what the twelfth rib is trying to tell us.